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Alrasheed AA, Alammar AM. Exploring Patient Preferences for Information About CT Radiation Exposure: Bridging the Gap Between Patient Preference and Physician Practice. Patient Prefer Adherence 2024; 18:1929-1938. [PMID: 39318368 PMCID: PMC11420885 DOI: 10.2147/ppa.s466115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 09/14/2024] [Indexed: 09/26/2024] Open
Abstract
Background CT scan utilizes ionizing radiation poses a danger to the patient's health. Thus, telling the patient about ionizing radiation would be critical in promoting shared decision-making and improving patient-doctor communication. However, few studies have examined this topic broadly. Objective The study was conducted to identify the frequency of physicians informing patients about the radiation risk before ordering a CT scan, as well as to examine the association between patients' demographic characteristics and their awareness of the radiation risks associated with CT scans. Methods A cross-sectional study was conducted among 387 patients who had undergone CT scans at a tertiary hospital in Riyadh, Saudi Arabia. Data were collected via phone interviews using a structured questionnaire. Chi-squared tests were employed to assess associations between patients' demographic characteristics and their awareness of CT scan radiation risks. Results When examining knowledge, 58% of patients knew that CT involves harmful radiation. This knowledge was significantly associated with higher education level and previous experience with CT scans. Regarding doctors' practice of providing information to patients about the scan, 344 (88.9%) patients indicated that their doctor had explained to them why they needed the scan. Only 28 (7.2%) patients stated that their doctor had mentioned the amount of radiation, and 74 (19.1%) patients indicated that doctors mentioned the risks associated with the radiation of the scan. Almost all patients (96.9%) preferred to be told about why they needed a CT scan. Conclusion The vast majority of patients who underwent CT scans did not receive enough information about the harm of the scans. However, most of them preferred to know about this harm.
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Affiliation(s)
- Abdullah A Alrasheed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman M Alammar
- King Saud University, King Saud University Medical City, Family and Community Medicine department, Riyadh, Saudi Arabia
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Lyons A, Mohammed Ali A, England A, Moore N, Young R, Leamy B, Tam W, Bezzina P, Pongnapang N, McEntee MF. Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a Single Institution. J Med Imaging Radiat Sci 2024; 55:101421. [PMID: 38735771 DOI: 10.1016/j.jmir.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography. METHODS Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations. RESULTS Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm2, respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm2. Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis). CONCLUSION TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.
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Affiliation(s)
- Andrew Lyons
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Ali Mohammed Ali
- Department of Medical Physics, College of Applied Medical Sciences, University of Kerbala, Karbala, Iraq
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
| | - Niamh Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - Brid Leamy
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Winnie Tam
- Department of Radiography, City, University of London, London, UK
| | - Paul Bezzina
- Department of Radiography, University of Malta, Msida, Malta
| | - Napapong Pongnapang
- Department of Radiological Technology, Mahidol University, Bangkok, Thailand
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
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Kibrom BT, Manyazewal T, Demma BD, Feleke TH, Kabtimer AS, Ayele ND, Korsa EW, Hailu SS. Emerging technologies in pediatric radiology: current developments and future prospects. Pediatr Radiol 2024; 54:1428-1436. [PMID: 39012407 DOI: 10.1007/s00247-024-05997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
Radiological imaging is a crucial diagnostic tool for the pediatric population. However, it is associated with several unique challenges in this age group compared to adults. These challenges mainly come from the fact that children are not small-sized adults and differ in development, anatomy, physiology, and pathology compared to adults. This paper reviews relevant articles published between January 2015 and October 2023 to analyze challenges associated with imaging technologies currently used in pediatric radiology, emerging technologies, and their role in resolving the challenges and future prospects of pediatric radiology. In recent decades, imaging technologies have advanced rapidly, developing advanced ultrasound, computed tomography, magnetic resonance, nuclear imaging, teleradiology, artificial intelligence, machine learning, three-dimensional printing, radiomics, and radiogenomics, among many others. By prioritizing the unique needs of pediatric patients while developing such technologies, we can significantly alleviate the challenges faced in pediatric radiology.
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Affiliation(s)
- Bethlehem T Kibrom
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Biruk D Demma
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfahunegn H Feleke
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Potomac Urology Clinic, Alexandria, VA, USA
| | | | - Nitsuh D Ayele
- College of Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Eyasu W Korsa
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samuel S Hailu
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kamarova S, Youens D, Ha NT, Bulsara M, Doust J, Fox R, Kritz M, McRobbie D, O'Leary P, Parizel PM, Slavotinek J, Wright C, Moorin R. Demonstrating the use of population level data to investigate trends in the rate, radiation dose and cost of Computed Tomography across clinical groups: Are there any areas of concern? J Med Radiat Sci 2024. [PMID: 38982690 DOI: 10.1002/jmrs.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Increases in computed tomography (CT) use may not always reflect clinical need or improve outcomes. This study aimed to demonstrate how population level data can be used to identify variations in care between patient groups, by analysing system-level changes in CT use around the diagnosis of new conditions. METHODS Retrospective repeated cross-sectional observational study using West Australian linked administrative records, including 504,723 adults diagnosed with different conditions in 2006, 2012 and 2015. For 90 days pre/post diagnosis, CT use (any and 2+ scans), effective dose (mSv), lifetime attributable risk (LAR) of cancer incidence and mortality from CT, and costs were assessed. RESULTS CT use increased from 209.4 per 1000 new diagnoses in 2006 to 258.0 in 2015; increases were observed for all conditions except neoplasms. Healthcare system costs increased for all conditions but neoplasms and mental disorders. Effective dose increased substantially for respiratory (+2.5 mSv, +23.1%, P < 0.001) and circulatory conditions (+2.1 mSv, +15.4%, P < 0.001). The LAR of cancer incidence and mortality from CT increased for endocrine (incidence +23.4%, mortality +18.0%) and respiratory disorders (+21.7%, +23.3%). Mortality LAR increased for circulatory (+12.1%) and nervous system (+11.0%) disorders. The LAR of cancer incidence and mortality reduced for musculoskeletal system disorders, despite an increase in repeated CT in this group. CONCLUSIONS Use and costs increased for most conditions except neoplasms and mental and behavioural disorders. More strategic CT use may have occurred in musculoskeletal conditions, while use and radiation burden increased for respiratory, circulatory and nervous system conditions. Using this high-level approach we flag areas requiring deeper investigation into appropriateness and value of care.
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Affiliation(s)
- Sviatlana Kamarova
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, New South Wales Health, Kingswood, New South Wales, Australia
| | - David Youens
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Ninh T Ha
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Notre Dame, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Fox
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Marlene Kritz
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Donald McRobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Leary
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - Paul M Parizel
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cameron Wright
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Davis JMK, Niazi MKK, Ricker AB, Tavolara TE, Robinson JN, Annanurov B, Smith K, Mantha R, Hwang J, Shrestha R, Iannitti DA, Martinie JB, Baker EH, Gurcan MN, Vrochides D. Predicting response to neoadjuvant chemotherapy for colorectal liver metastasis using deep learning on prechemotherapy cross-sectional imaging. J Surg Oncol 2024; 130:93-101. [PMID: 38712939 DOI: 10.1002/jso.27673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Deep learning models (DLMs) are applied across domains of health sciences to generate meaningful predictions. DLMs make use of neural networks to generate predictions from discrete data inputs. This study employs DLM on prechemotherapy cross-sectional imaging to predict patients' response to neoadjuvant chemotherapy. METHODS Adult patients with colorectal liver metastasis who underwent surgery after neoadjuvant chemotherapy were included. A DLM was trained on computed tomography images using attention-based multiple-instance learning. A logistic regression model incorporating clinical parameters of the Fong clinical risk score was used for comparison. Both model performances were benchmarked against the Response Evaluation Criteria in Solid Tumors criteria. A receiver operating curve was created and resulting area under the curve (AUC) was determined. RESULTS Ninety-five patients were included, with 33,619 images available for study inclusion. Ninety-five percent of patients underwent 5-fluorouracil-based chemotherapy with oxaliplatin and/or irinotecan. Sixty percent of the patients were categorized as chemotherapy responders (30% reduction in tumor diameter). The DLM had an AUC of 0.77. The AUC for the clinical model was 0.41. CONCLUSIONS Image-based DLM for prediction of response to neoadjuvant chemotherapy in patients with colorectal cancer liver metastases was superior to a clinical-based model. These results demonstrate potential to identify nonresponders to chemotherapy and guide select patients toward earlier curative resection.
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Affiliation(s)
- Joshua M K Davis
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Muhammad Khalid Khan Niazi
- Center for Artificial Intelligence Research and the Clinical Image Analysis Lab, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ansley B Ricker
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Thomas E Tavolara
- Center for Artificial Intelligence Research and the Clinical Image Analysis Lab, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jordan N Robinson
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Bayram Annanurov
- Center for Artificial Intelligence Research and the Clinical Image Analysis Lab, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kaylee Smith
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Rohit Mantha
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Jimmy Hwang
- Department of Medical Oncology, Atrium Health Carolinas Medical Center, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Ruchi Shrestha
- Department of Radiology, Atrium Health, Charlotte, North Carolina, USA
| | - David A Iannitti
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - John B Martinie
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Erin H Baker
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Metin N Gurcan
- Center for Artificial Intelligence Research and the Clinical Image Analysis Lab, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Dionisios Vrochides
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA
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Caramenti L, Gradowska PL, Moriña D, Byrnes G, Cardis E, Hauptmann M. Finite-Sample Bias of the Linear Excess Relative Risk in Cohort Studies of Computed Tomography-Related Radiation Exposure and Cancer. Radiat Res 2024; 201:206-214. [PMID: 38323646 DOI: 10.1667/rade-23-00187.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
The linear excess relative risk (ERR) is the most commonly reported measure of association in radiation epidemiological studies, when individual dose estimates are available. While the asymptotic properties of the ERR estimator are well understood, there is evidence of small sample bias in case-control studies of treatment-related radiation exposure and second cancer risk. Cohort studies of cancer risk after exposure to low doses of radiation from diagnostic procedures, e.g., computed tomography (CT) examinations, typically have small numbers of cases and risks are small. Therefore, understanding the properties of the estimated ERR is essential for interpretation and analysis of such studies. We present results of a simulation study that evaluates the finite-sample bias of the ERR estimated by time-to-event analyses and its confidence interval using simulated data, resembling a retrospective cohort study of radiation-related leukemia risk after CT examinations in childhood and adolescence. Furthermore, we evaluate how the Firth-corrected estimator reduces the finite-sample bias of the classical estimator. We show that the ERR is overestimated by about 30% for a cohort of about 150,000 individuals, with 42 leukemia cases observed on average. The bias is reduced for higher baseline incidence rates and for higher values of the true ERR. As the number of cases increases, the ERR is approximately unbiased. The Firth correction reduces the bias for all cohort sizes to generally around or under 5%. Epidemiological studies showing an association between radiation exposure from pediatric CT and cancer risk, unless very large, may overestimate the magnitude of the relationship, while there is no evidence of an increased chance for false-positive results. Conducting large studies, perhaps by pooling individual studies to increase the number of cases, should be a priority. If this is not possible, Firth correction should be applied to reduce small-sample bias.
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Affiliation(s)
- L Caramenti
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane; Neuruppin, Germany
| | - P L Gradowska
- Erasmus MC Cancer Institute; Rotterdam, The Netherlands
| | - D Moriña
- Department of Econometrics, Statistics and Applied Economics, Riskcenter-IREA, Universitat de Barcelona (UB); Barcelona, Spain
| | - G Byrnes
- International Agency for Research in Cancer (IARC); Lyon, France
| | - E Cardis
- Institute for Global Health, ISGlobal; Barcelona, Spain
- Universitat Pompeu Fabra (UPF); Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
| | - M Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane; Neuruppin, Germany
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7
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Tong X, Fang X, Wang S, Fan Y, Wei W, Xiao Q, Chen A, Liu Y, Liu L. Opportunistic screening for osteoporosis using enhanced images based on dual-energy computed tomography material decomposition: a comparison with quantitative computed tomography. Quant Imaging Med Surg 2024; 14:352-364. [PMID: 38223059 PMCID: PMC10784008 DOI: 10.21037/qims-23-855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/07/2023] [Indexed: 01/16/2024]
Abstract
Background Many patients with malignant tumors require chemotherapy and radiation therapy, which can result in a decline in physical function and potentially influence bone mineral density (BMD). Furthermore, these treatments necessitate enhanced computed tomography (CT) scans for determining disease staging or treatment outcomes, and opportunistic screening with available imaging data is beneficial for patients at high risk for osteoporosis if existing imaging data can be used. The study aimed to investigate the feasibility of opportunistic screening for osteoporosis using enhanced CT based on a dual-energy CT (DECT) material decomposition technique. Methods We prospectively enrolled 346 consecutive patients who underwent abdominal unenhanced and triphasic contrast-enhanced CT (arterial, portal venous, and delayed phases) between June 2021 and June 2022. The BMD, and the density of hydroxyapatite (HAP) on HAP-iodine images and calcium (Ca) on Ca-iodine images were measured on the L1-L3 vertebral bodies. The iodine intake was recorded. Pearson analysis was conducted to assess the correlation between iodine intake and the density values in three phases and the correlation between BMD and the densities of HAP and Ca. Furthermore, linear regression was employed for quantitative evaluation. Bland-Altman analysis was used to evaluate the agreement between calculated BMD derived from DECT (BMD-DECT) and reference BMD derived from quantitative CT (BMD-QCT). Receiver operating characteristic (ROC) analysis was applied to assess the diagnostic efficacy. Results The HAP and Ca density of the L1-L3 vertebral bodies did not differ significantly among the three phases of contrast-enhanced CT (F=0.001-0.049; P>0.05). Significant positive correlations were found between HAP, Ca densities, and BMD (HAP-BMD: r=0.9472, R2=0.8973; Ca-BMD: r=0.9470, R2=0.8968; all P<0.001). Bland-Altman plots showed high agreement between BMD-DECT and BMD-QCT. The area under the curve (AUC) using HAP and Ca measurements was 0.963 [95% confidence interval (CI): 0.937-0.980] and 0.964 (95% CI: 0.939-0.981), respectively, for diagnosing osteoporosis and was 0.951 (95% CI: 0.917-0.973) and 0.950 (95% CI: 0.916-0.973), respectively, for diagnosing osteopenia. Conclusions The HAP and Ca density measurements generated through the material decomposition technique in DECT have good diagnostic performances in assessing BMD, which offers a new perspective for opportunistic screening of osteoporosis on contrast-enhanced CT.
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Affiliation(s)
- Xiaoyu Tong
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Fang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shigeng Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yong Fan
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Wei
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingzhu Xiao
- School of Investment and Project Management, Dongbei University of Finance and Economics, Dalian, China
| | - Anliang Chen
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yijun Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lei Liu
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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8
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Bosch de Basea Gomez M, Thierry-Chef I, Harbron R, Hauptmann M, Byrnes G, Bernier MO, Le Cornet L, Dabin J, Ferro G, Istad TS, Jahnen A, Lee C, Maccia C, Malchair F, Olerud H, Simon SL, Figuerola J, Peiro A, Engels H, Johansen C, Blettner M, Kaijser M, Kjaerheim K, Berrington de Gonzalez A, Journy N, Meulepas JM, Moissonnier M, Nordenskjold A, Pokora R, Ronckers C, Schüz J, Kesminiene A, Cardis E. Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults. Nat Med 2023; 29:3111-3119. [PMID: 37946058 PMCID: PMC10719096 DOI: 10.1038/s41591-023-02620-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent CT examinations before age 22 years in nine European countries. Radiation doses to the active bone marrow were estimated on the basis of body part scanned, patient characteristics, time period and inferred CT technical parameters. We found an association between cumulative dose and risk of all hematological malignancies, with an excess relative risk of 1.96 (95% confidence interval 1.10 to 3.12) per 100 mGy (790 cases). Similar estimates were obtained for lymphoid and myeloid malignancies. Results suggest that for every 10,000 children examined today (mean dose 8 mGy), 1-2 persons are expected to develop a hematological malignancy attributable to radiation exposure in the subsequent 12 years. Our results strengthen the body of evidence of increased cancer risk at low radiation doses and highlight the need for continued justification of pediatric CT examinations and optimization of doses.
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Affiliation(s)
- Magda Bosch de Basea Gomez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Richard Harbron
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Graham Byrnes
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Maria-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Lucian Le Cornet
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Gilles Ferro
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Tore S Istad
- Norwegian Radiation and Nuclear Safety Authority, Oslo, Norway
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), Sèvres, France
| | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), Sèvres, France
| | - Hilde Olerud
- Norwegian Radiation and Nuclear Safety Authority, Oslo, Norway
- Norwegian Radiation Protection Authority, Østerås, Norway
- University of South-Eastern Norway, Kongsberg, Norway
| | - Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Peiro
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Hilde Engels
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Christoffer Johansen
- Cancer Late Effect Research Oncology Clinic (CASTLE), Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Magnus Kaijser
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Institute of Cancer Research, London, UK
| | - Neige Journy
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France
| | | | - Monika Moissonnier
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Arvid Nordenskjold
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Cecile Ronckers
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
- Pompeu Fabra University, Barcelona, Spain.
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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9
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Gupta RV, Kalra MK, Ebrahimian S, Kaviani P, Primak A, Bizzo B, Dreyer KJ. Complex Relationship Between Artificial Intelligence and CT Radiation Dose. Acad Radiol 2022; 29:1709-1719. [PMID: 34836775 DOI: 10.1016/j.acra.2021.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/22/2022]
Abstract
Concerns over need for CT radiation dose optimization and reduction led to improved scanner efficiency and introduction of several reconstruction techniques and image processing-based software. The latest technologies use artificial intelligence (AI) for CT dose optimization and image quality improvement. While CT dose optimization has and can benefit from AI, variations in scanner technologies, reconstruction methods, and scan protocols can lead to substantial variations in radiation doses and image quality across and within different scanners. These variations in turn can influence performance of AI algorithms being deployed for tasks such as detection, segmentation, characterization, and quantification. We review the complex relationship between AI and CT radiation dose.
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Affiliation(s)
- Reya V Gupta
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 248, Boston, Massachusetts
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 248, Boston, Massachusetts.
| | - Shadi Ebrahimian
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 248, Boston, Massachusetts
| | - Parisa Kaviani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 248, Boston, Massachusetts
| | - Andrew Primak
- Siemens Medical Solutions USA Inc, Malvern, Pennsylvania
| | - Bernardo Bizzo
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 248, Boston, Massachusetts; MGH & BWH Center for Clinical Data Science, Boston, Massachusetts
| | - Keith J Dreyer
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Suite 248, Boston, Massachusetts; MGH & BWH Center for Clinical Data Science, Boston, Massachusetts
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10
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Draelos RL, Carin L. Explainable multiple abnormality classification of chest CT volumes. Artif Intell Med 2022; 132:102372. [DOI: 10.1016/j.artmed.2022.102372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/09/2022] [Accepted: 07/28/2022] [Indexed: 12/20/2022]
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11
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Richard S, Gabriel S, John S, Emmanuel M, John-Mary V. The focused quantitative EEG bio-marker in studying childhood atrophic encephalopathy. Sci Rep 2022; 12:13437. [PMID: 35927445 PMCID: PMC9352776 DOI: 10.1038/s41598-022-17062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
Although it is a normal involution process in advanced age, brain atrophy—also termed atrophic encephalopathy—can also occur prematurely in childhood as a consequential effect of brain tissues injury through trauma or central nervous system infection, though in both normal and premature occurrences this condition always presents with loss of volume relative to the skull. A common tool for the functional study of brain activities is an electroencephalogram, but analyses of this have reportedly identified mismatches between qualitative and quantitative forms, particularly in the use of Delta-alpha ratio (DAR) indices, meaning that the values may be case dependent. The current study thus examines the value of Focused Occipital Beta-Alpha Ratio (FOBAR) as a modified biomarker for evaluating brain functional changes resulting from brain atrophy. This cross-sectional design study involves 260 patients under 18 years of age. Specifically, 207 patients with brain atrophy are compared with 53 control subjects with CT scan-proven normal brain volume. All the children underwent digital electroencephalography with brain mapping. Results show that alpha posterior dominant rhythm was present in 88 atrophic children and 44 controls. Beta as posterior dominant rhythm was present in an overwhelming 91.5% of atrophic subjects, with 0.009 p-values. The focused occipital Beta-alpha ratio correlated significantly with brain volume loss presented in diagonal brain fraction. The FOBAR and DAR values of the QEEG showed no significant correlation. This work concludes that QEEG cerebral dysfunctional studies may be etiologically and case dependent from the nature of the brain injury. Also, the focused Beta-alpha ratio of the QEEG is a prospective and potential biomarker of consideration in studying childhood atrophic encephalopathy.
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Affiliation(s)
- Sungura Richard
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela-African Institution of Science and Technology, Arusha, Tanzania.
| | - Shirima Gabriel
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela-African Institution of Science and Technology, Arusha, Tanzania
| | - Spitsbergen John
- Department of Neuroscience, Western Michigan University, Kalamazoo, MI, USA
| | - Mpolya Emmanuel
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela-African Institution of Science and Technology, Arusha, Tanzania
| | - Vianney John-Mary
- Department of Health and Biomedical Sciences, School of Life Science, Nelson Mandela-African Institution of Science and Technology, Arusha, Tanzania
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12
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Shi HM, Sun ZC, Ju FH. Understanding the harm of low‑dose computed tomography radiation to the body (Review). Exp Ther Med 2022; 24:534. [PMID: 35911849 DOI: 10.3892/etm.2022.11461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hai-Min Shi
- Department of Gynecology and Obstetrics Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhi-Chao Sun
- Department of Medical Imaging, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Fang-He Ju
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310006, P.R. China
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13
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Sapignoli S, Roggio A, Boschini A, Guida F, Merlo C, Paiusco M, Zorz A, De Monte F. Size-specific dose estimates for pediatric head CT protocols based on the AAPM report TG-293. Phys Med 2022; 100:26-30. [PMID: 35717776 DOI: 10.1016/j.ejmp.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/26/2022] [Accepted: 06/11/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To establish the Size Specific Dose Estimate (SSDE) typical values for pediatric head CT examinations based on the AAPM report TG-293; to provide a new stratification based on the water-equivalent diameter (Dw), given that SSDE is related to the head size. METHODS 296 Head CT scans of pediatric patients collected using a dose monitoring software were retrospectively analysed. Typical values were derived stratifying data by age in three methods: the first proposed by the European Guidelines on Diagnostic Reference Levels for Pediatric Imaging (RP185), the second by the National Istisan Report 20/22 and a local one related to the clinical protocols (LStrata). For each scan, a self-developed Matlab routine calculated the water-equivalent diameter (Dw) and related SSDE values with the conversion factors fH16and fB16provided by the AAPM reports TG-293 and TG-204, respectively. Eventually, a Dwstratification was introduced starting from a measure of the lateral dimension of the head. RESULTS SSDE based on TG-204 overestimatesthe dose up to 12%. Four Dwgroups were identified thanks to the good correlation between the head lateral dimension andDw: Dw < 14 cm, 14 ≤ Dw < 16 cm, 16 ≤ Dw< 17 cm, Dw≥ 17 cm. The Dw-stratified dosimetric indices presentgreater variability than those grouped by age because of the large variability of the size of the infant's head. CONCLUSIONS The variability of the SSDE metric underlines that age-optimized protocols are not when size is considered.
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Affiliation(s)
- Sonia Sapignoli
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Roggio
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alessio Boschini
- Medical Physics Department, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Federica Guida
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carlo Merlo
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marta Paiusco
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alessandra Zorz
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
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14
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Koch V, Albrecht MH, Gruenewald LD, Yel I, Eichler K, Gruber-Rouh T, Hammerstingl RM, Burck I, Wichmann JL, Alizadeh LS, Vogl TJ, Lenga L, Wesarg S, Martin SS, Mader C, Dimitrova M, D'Angelo T, Booz C. Impact of Intravenously Injected Contrast Agent on Bone Mineral Density Measurement in Dual-Source Dual-Energy CT. Acad Radiol 2022; 29:880-887. [PMID: 34266738 DOI: 10.1016/j.acra.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the influence of intravenously injected contrast agent on bone mineral density (BMD) assessment in dual-source dual-energy CT. METHODS This retrospective study included 1,031 patients (mean age, 53 ± 7 years; 519 women) who had undergone third-generation dual-source dual-energy CT in context of tumor staging between January 2019 and December 2019. Dedicated postprocessing software based on material decomposition was used for phantomless volumetric BMD assessment of trabecular bone of the lumbar spine. Volumetric trabecular BMD values derived from unenhanced and contrast-enhanced portal venous phase were compared by calculating correlation and agreement analyses using Pearson product-moment correlation, linear regression, and Bland-Altman plots. RESULTS Mean BMD values were 115.53 ± 37.23 and 116.10 ± 37.78 mg/cm3 in unenhanced and contrast-enhanced dual-energy CT series, respectively. Values from contrast-enhanced portal venous phase differed not significantly from those of the unenhanced phase (p = 0.44) and showed high correlation (r = 0.971 [95% CI, 0.969-0.973]) with excellent agreement in Bland-Altman plots. Mean difference of the two phases was 0.61 mg/cm3 (95% limits of agreement, -17.14 and 18.36 mg/cm3). CONCLUSION Portal venous phase dual-source dual-energy CT allows for accurate opportunistic BMD assessment of trabecular bone of the lumbar spine compared to unenhanced imaging. Therefore, dual-source CT may provide greater flexibility regarding BMD assessment in clinical routine and reduce radiation exposure by avoiding additional osteodensitometry examinations, as contrast-enhanced CT scans in context of tumor staging are increasingly performed in dual-energy mode.
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Affiliation(s)
- Vitali Koch
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Leon D Gruenewald
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Renate M Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Wesarg
- Fraunhofer IGD, Cognitive Computing & Medical Imaging, Darmstadt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christoph Mader
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mirela Dimitrova
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
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15
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Van Erck D, Moeskops P, Schoufour JD, Weijs PJM, Scholte Op Reimer WJM, Van Mourik MS, Janmaat YC, Planken RN, Vis M, Baan J, Hemke R, Išgum I, Henriques JP, De Vos BD, Delewi R. Evaluation of a Fully Automatic Deep Learning-Based Method for the Measurement of Psoas Muscle Area. Front Nutr 2022; 9:781860. [PMID: 35634380 PMCID: PMC9133929 DOI: 10.3389/fnut.2022.781860] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/14/2022] [Indexed: 01/06/2023] Open
Abstract
Background Manual muscle mass assessment based on Computed Tomography (CT) scans is recognized as a good marker for malnutrition, sarcopenia, and adverse outcomes. However, manual muscle mass analysis is cumbersome and time consuming. An accurate fully automated method is needed. In this study, we evaluate if manual psoas annotation can be substituted by a fully automatic deep learning-based method. Methods This study included a cohort of 583 patients with severe aortic valve stenosis planned to undergo Transcatheter Aortic Valve Replacement (TAVR). Psoas muscle area was annotated manually on the CT scan at the height of lumbar vertebra 3 (L3). The deep learning-based method mimics this approach by first determining the L3 level and subsequently segmenting the psoas at that level. The fully automatic approach was evaluated as well as segmentation and slice selection, using average bias 95% limits of agreement, Intraclass Correlation Coefficient (ICC) and within-subject Coefficient of Variation (CV). To evaluate performance of the slice selection visual inspection was performed. To evaluate segmentation Dice index was computed between the manual and automatic segmentations (0 = no overlap, 1 = perfect overlap). Results Included patients had a mean age of 81 ± 6 and 45% was female. The fully automatic method showed a bias and limits of agreement of -0.69 [-6.60 to 5.23] cm2, an ICC of 0.78 [95% CI: 0.74-0.82] and a within-subject CV of 11.2% [95% CI: 10.2-12.2]. For slice selection, 84% of the selections were on the same vertebra between methods, bias and limits of agreement was 3.4 [-24.5 to 31.4] mm. The Dice index for segmentation was 0.93 ± 0.04, bias and limits of agreement was -0.55 [1.71-2.80] cm2. Conclusion Fully automatic assessment of psoas muscle area demonstrates accurate performance at the L3 level in CT images. It is a reliable tool that offers great opportunities for analysis in large scale studies and in clinical applications.
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Affiliation(s)
- Dennis Van Erck
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | - Josje D. Schoufour
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, Netherlands
| | - Peter J. M. Weijs
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Wilma J. M. Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- HU University of Applied Sciences, Research Group Chronic Diseases, Utrecht, Netherlands
| | - Martijn S. Van Mourik
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Yvonne C. Janmaat
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - R. Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherslands
| | - Marije Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherslands
| | - Ivana Išgum
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherslands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - José P. Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bob D. De Vos
- Quantib-U, Rotterdam, Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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16
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Pak F, Hosseini Pooya SM, Shabani H, Baradaran S, Salim Sadeq U. COMPARISON OF CBCT AND CT IN TERMS OF DOSE VALUE OF ORGANS AT RISK IN PARANASAL SINUS IMAGING. RADIATION PROTECTION DOSIMETRY 2022; 198:208-213. [PMID: 35253875 DOI: 10.1093/rpd/ncac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Irradiated dose to the organs at risk surrounding the paranasal sinuses was compared in cone beam computed tomography (CBCT) and multi spiral computed tomography with respect to the organs' relative positions to the imaging field. A head and neck Alderson-Rando phantom equipped with thermoluminescence dosemeters pellets was irradiated according to three routine CBCT protocols and one protocol in multi spiral computed tomography. Dose value of organs outside the imaging field as well as those measured dose of organs inside the field were assessed. The highest measured doses were obtained from CT scan for most of the organs investigated in this study, whereas the lowest one was associated with the low-resolution mode of CBCT. Also, statistical analysis showed no significant differences between the dose values of out-of-field organs in all CBCT modes, whereas significant differences were observed between the radiation doses of CT and CBCT modes for all organs at risk inside and outside of the imaging field. CBCT is recommended on the basis of having a lower dose; however, the image qualities were the same in the two employed modalities, so the approach of lower dose can be made.
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Affiliation(s)
- Farideh Pak
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 14177-44361 Tehran, Iran
| | | | - Hamed Shabani
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 14177-44361 Tehran, Iran
| | - Samaneh Baradaran
- Nuclear Science & Technology Research Institute, 14395-836 Tehran, Iran
| | - Ula Salim Sadeq
- Radiation Sciences Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 14177-44361 Tehran, Iran
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17
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Shankar SS, Jadick GL, Hoffman EA, Atha J, Sieren JC, Samei E, Abadi E. Scanner-specific validation of a CT simulator using a COPD-emulated anthropomorphic phantom. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12031:120313R. [PMID: 35547178 PMCID: PMC9087304 DOI: 10.1117/12.2613212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Traditional methods of quantitative analysis of CT images typically involve working with patient data, which is often expensive and limited in terms of ground truth. To counter these restrictions, quantitative assessments can instead be made through Virtual Imaging Trials (VITs) which simulate the CT imaging process. This study sought to validate DukeSim (a scanner-specific CT simulator) utilizing clinically relevant biomarkers for a customized anthropomorphic chest phantom. The physical phantom was imaged utilizing two commercial CT scanners (Siemens Somatom Force and Definition Flash) with varying imaging parameters. A computational version of the phantom was simulated utilizing DukeSim for each corresponding real acquisition. Biomarkers were computed and compared between the real and virtually acquired CT images to assess the validity of DukeSim. The simulated images closely matched the real images both qualitatively and quantitatively, with the average biomarker percent difference of 3.84% (range 0.19% to 18.27%). Results showed that DukeSim is reasonably well validated across various patient imaging conditions and scanners, which indicates the utility of DukeSim for further VIT studies where real patient data may not be feasible.
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Affiliation(s)
- Sachin S Shankar
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University
- Department of Electrical and Computer Engineering, Duke University
| | - Giavanna L Jadick
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University
| | - Eric A Hoffman
- Department of Radiology, University of Iowa
- Department of Biomedical Engineering, University of Iowa
| | | | - Jessica C Sieren
- Department of Radiology, University of Iowa
- Department of Biomedical Engineering, University of Iowa
| | - Ehsan Samei
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University
- Department of Electrical and Computer Engineering, Duke University
| | - Ehsan Abadi
- Center for Virtual Imaging Trials, Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University
- Department of Electrical and Computer Engineering, Duke University
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18
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Dewi WK, Anam C, Hidayanto E, Wati AL, Dougherty G. CORRELATION BETWEEN ANTERIOR-POSTERIOR AND LATERAL DIMENSIONS WITH THE EFFECTIVE AND WATER-EQUIVALENT DIAMETERS IN AXIAL IMAGES FROM HEAD COMPUTED TOMOGRAPHY EXAMINATIONS. RADIATION PROTECTION DOSIMETRY 2021; 196:248-256. [PMID: 34580737 DOI: 10.1093/rpd/ncab144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
The study aims to correlate the effective diameter (Deff) and water-equivalent diameter (Dw) parameters with anterior-posterior (AP), lateral (LAT) and AP + LAT dimensions in order to estimate the patient dose in head CT examinations. Seventy-four patient datasets from head CT examinations were retrospectively collected. The patient's sizes were calculated from the middle slice using a software of IndoseCT. Dw and Deff were plotted as functions of AP, LAT and AP + LAT dimensions. The best trendline fit for LAT and AP functions was a second order polynomial, which resulted in R2 of 0.89 for Deff vs LAT, 0.88 for Dw vs LAT, 0.92 for Deff vs AP and 0.91 for Dw vs AP. A linear correlation was found for Deff vs AP + LAT, Dw vs AP + LAT and Dw vs Deff with R2 of 0.97, 0.96 and 0.98, respectively.
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Affiliation(s)
- Winda Kusuma Dewi
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Semarang, Central Java, Indonesia
| | - Choirul Anam
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Semarang, Central Java, Indonesia
| | - Eko Hidayanto
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Semarang, Central Java, Indonesia
| | - Annisa Lidia Wati
- Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Semarang, Central Java, Indonesia
| | - Geoff Dougherty
- Department of Applied Physics and Medical Imaging, California State University Channel Islands, Camarillo, CA 93012, USA
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Hwang JY, Choi YH, Yoon HM, Ryu YJ, Shin HJ, Kim HG, Lee SM, You SK, Park JE. Establishment of Local Diagnostic Reference Levels of Pediatric Abdominopelvic and Chest CT Examinations Based on the Body Weight and Size in Korea. Korean J Radiol 2021; 22:1172-1184. [PMID: 33856132 PMCID: PMC8236355 DOI: 10.3348/kjr.2020.0890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purposes of this study were to analyze the radiation doses for pediatric abdominopelvic and chest CT examinations from university hospitals in Korea and to establish the local diagnostic reference levels (DRLs) based on the body weight and size. MATERIALS AND METHODS At seven university hospitals in Korea, 2494 CT examinations of patients aged 15 years or younger (1625 abdominopelvic and 869 chest CT examinations) between January and December 2017 were analyzed in this study. CT scans were transferred to commercial automated dose management software for the analysis after being de-identified. DRLs were calculated after grouping the patients according to the body weight and effective diameter. DRLs were set at the 75th percentile of the distribution of each institution's typical values. RESULTS For body weights of 5, 15, 30, 50, and 80 kg, DRLs (volume CT dose index [CTDIvol]) were 1.4, 2.2, 2.7, 4.0, and 4.7 mGy, respectively, for abdominopelvic CT and 1.2, 1.5, 2.3, 3.7, and 5.8 mGy, respectively, for chest CT. For effective diameters of < 13 cm, 14-16 cm, 17-20 cm, 21-24 cm, and > 24 cm, DRLs (size-specific dose estimates [SSDE]) were 4.1, 5.0, 5.7, 7.1, and 7.2 mGy, respectively, for abdominopelvic CT and 2.8, 4.6, 4.3, 5.3, and 7.5 mGy, respectively, for chest CT. SSDE was greater than CTDIvol in all age groups. Overall, the local DRL was lower than DRLs in previously conducted dose surveys and other countries. CONCLUSION Our study set local DRLs in pediatric abdominopelvic and chest CT examinations for the body weight and size. Further research involving more facilities and CT examinations is required to develop national DRLs and update the current DRLs.
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Affiliation(s)
- Jae Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea.
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Gi Kim
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sun Kyung You
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji Eun Park
- Department of Radiology, Ajou University Hospital, School of Medicine, Ajou University, Suwon, Korea
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Jalal M, Rosendahl J, Campbell JA, Vinayagam R, Al-Mukhtar A, Hopper AD. Identification of "Digital Sarcopenia" Can Aid the Detection of Pancreatic Exocrine Insufficiency and Malnutrition Assessment in Patients with Suspected Pancreatic Pathology. Dig Dis 2021; 40:335-344. [PMID: 34102640 DOI: 10.1159/000517554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pancreatic exocrine insufficiency (PEI) and subsequent malnutrition can be difficult to diagnose but lead to sarcopenia and increased mortality and morbidity even in benign disease. Digital skeletal muscle analysis has been increasingly recognised as a tool to diagnose sarcopenia. OBJECTIVE The aim of the study was to assess the prevalence of sarcopenia in patients with PEI secondary to benign disease using novel skeletal muscle recognition software. METHODS Prospective recruitment of patients referred for endoscopic ultrasound (EUS) with suspected pancreatic pathology. Patients with suspected pancreatic cancer on initial computed tomography (CT) were excluded. The diagnosis of chronic pancreatitis (CP) was based on CT and EUS findings. PEI was assessed with faecal elastase-1. Digital measurement of skeletal muscle mass identified sarcopenia, with demographic and comorbidity data also collected. RESULTS PEI was identified in 45.1% (46/102) of patients recruited, and 29.4% (30/102) had changes of CP. Sarcopenia was significantly more prevalent in PEI 67.4% (31/46) than no-PEI 37.5% (21/56) (37.5%), regardless of CP changes (p < 0.003). The prevalence of sarcopenia (67% vs. 35%; p = 0.02) and sarcopenic obesity (68.4% vs. 25%; p = 0.003) was significantly higher when PEI was present without a radiological diagnosis of CP. Multivariate analysis identified sarcopenia and diabetes to be independently associated with PEI (odds ratio 4.8 and 13.8, respectively, p < 0.05). CONCLUSION Sarcopenia was strongly associated with PEI in patients undergoing assessment for suspected benign pancreatic pathology. Digital skeletal muscle assessment can be used as a tool to aid identification of sarcopenia in patients undergoing CT scan for pancreatic symptoms.
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Affiliation(s)
- Mustafa Jalal
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Jonas Rosendahl
- Department of Gastroenterology, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Jennifer A Campbell
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Ragu Vinayagam
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Ahmed Al-Mukhtar
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Andrew D Hopper
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
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21
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Mahaffey AL. Prominence of Analytical Chemistry in Modern-Day Healthcare: Current Medical Discoveries, Student Perspectives, and Systems Thinking. Anal Chem 2021; 93:4775-4781. [PMID: 33689291 DOI: 10.1021/acs.analchem.1c00041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the course of two years (2018 and 2020), anatomists and medical professionals became wonderstruck by two significant organ discoveries. The findings were previously undetected by conventional standards of medicine. Two different research groups and specialties, nonetheless, relied on applications founded on the principles of analytical chemistry education and techniques. In this article, I penned a discussion on both medical discoveries birthed through analytical processes. Secondarily, an examination of student perspectives on the versatility of analytical chemistry in healthcare and a review of the seemingly minimal representation (toward awareness) of analytical chemistry in health sciences programs are presented: Should there be a higher representation of analytical chemistry topics in undergraduate and graduate health profession programs? If so, what would be the plan of action? Increased notability of analytical chemistry in health sciences textbooks? Or the inception of a nontechnical novel analytical chemistry course for health sciences majors? Here, I attempt to answer these questions and present a plausible solution with the goal of acknowledging the prominence of analytical chemistry in medicine today.
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Affiliation(s)
- Angela L Mahaffey
- Marcella Niehoff School of Nursing, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, Illinois 60660, United States
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22
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Ploussi A, Syrgiamiotis V, Makri T, Hatzigiorgi C, Efstathopoulos EP. Local diagnostic reference levels in pediatric CT examinations: a survey at the largest children's hospital in Greece. Br J Radiol 2020; 93:20190358. [PMID: 32976036 PMCID: PMC7716000 DOI: 10.1259/bjr.20190358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The increased frequency of pediatric CT examinations and the high radiosensitivity of children entail the need to determine DRLs and optimize CT protocols. The aim of the study was twofold. Firstly, to establish pediatric LDRLs according to age and weight for the most common types of CT examinations at the largest children's hospital in Greece. Secondly, to compare LDRLs with European DRLs. METHODS A total of 756 pediatric patients who underwent head, chest, and abdomen-pelvis CT examinations were included. Patients were categorized into age groups according to the hospital's protocols. All CT examinations were performed using iterative reconstruction algorithm and AEC. LDRLs were determined in terms of 75th percentile of CTDIvol and DLP. Values of LDRLs were subsequently regrouped into weight categories and compared with European DRLs. RESULTS Gathering all age groups for head CT examinations and all weight groups for body CT examinations, LDRLs were ranged from (22-68, 2-5, 2-10) mGy in terms of CTDIvol; (317-786, 22-168, 58-425) mGy.cm in terms of DLP per acquisition and (324-838, 42-265, 85-498) mGy.cm in terms of total DLP for head, chest and abdomen-pelvis CT examinations, respectively. CONCLUSION CTDI LDRLs were comparable to European DRLs for head and either comparable or lower than European DRLs for body CT examinations. DLP LDRLs were higher than European DRLs for head and lower for body CT examinations. ADVANCES IN KNOWLEDGE Age- and weight-based LDRLs for pediatric CT examinations were established for the largest children's hospital in Greece. Further investigations across the country are required for the establishment of national pediatric DRLs in Greece.
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Affiliation(s)
- Agapi Ploussi
- 2nd Department of Radiology, University General Hospital ‘Attikon’, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | | | | | | | - Efstathios P. Efstathopoulos
- 2nd Department of Radiology, University General Hospital ‘Attikon’, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
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23
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Weyh AM, Dolan JM, Busby EM, Smith SE, Parsons ME, Norse AB, Godwin SA, Salman SO. Validated image ordering guidelines for odontogenic infections. Int J Oral Maxillofac Surg 2020; 50:627-634. [PMID: 33144048 DOI: 10.1016/j.ijom.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
Overuse of computed tomography (CT) is a prevalent problem across multiple disciplines in healthcare and is common in the workup of odontogenic infections. To address this problem, an imaging pathway was created through collaboration of the oral maxillofacial surgery and emergency medicine departments to reduce unnecessary CT orders. A prospective study was implemented to assess the success of the imaging pathway to guide in the selection of the most appropriate radiological imaging modality when managing an odontogenic infection. Subjects included were adults, presenting through the emergency department for confirmed odontogenic infection. The primary outcome was the rate of unnecessary CT scans performed after the introduction of the pathway. Statistics were performed via the t-test, χ2 test, and multiple regression analysis; P < 0.05 was considered significant. Between February 1 and December 15, 2019, 100 patients met the inclusion criteria and were enrolled. The rate of unnecessary CT scans was 25.6%, compared to 56.6% prior to the introduction of the imaging pathway. The pathway did not misclassify any patient to not receive a CT when it was medically necessary. Use of the imaging pathway has the potential to reduce unnecessary CT imaging for odontogenic infections, without negatively affecting patient outcomes.
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Affiliation(s)
- A M Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - J M Dolan
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - E M Busby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - S E Smith
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - M E Parsons
- Department of Emergency Medicine, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - A B Norse
- Department of Emergency Medicine, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - S A Godwin
- Department of Emergency Medicine, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - S O Salman
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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24
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van der Merwe CM, Mahomed N. An audit of radiation doses received by paediatric patients undergoing computed tomography investigations at academic hospitals in South Africa. SA J Radiol 2020; 24:1823. [PMID: 33240540 PMCID: PMC7669994 DOI: 10.4102/sajr.v24i1.1823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Diagnostic reference levels (DRLs) are a crucial element of auditing radiation doses in paediatric computed tomography (CT). Currently, there are no national paediatric CT DRLs in South Africa. Objectives The aim of this article was to establish local paediatric DRLs for CT examinations at two academic hospitals and to compare paediatric CT radiation output levels with established DRLs in the developed and developing world. Method Computed Tomography Dose Indexvolume (CTDIvol) and dose length product (DLP) values were collected from CT examinations performed at two university hospitals for patients aged 0–15 years, during 01 November 2016–30 April 2017. The 75th percentile of the data distribution was calculated for each CT examination type and age group, further categorised into routine working hours and after-hours for both hospitals and statistically compared. Results Of the 1031 CT examinations performed, CT brain examination was the most common (755/1031; 72.23%). DLP values were increased in the after-hours categories compared to regular working hours at both hospitals. The largest increase was in the 0–1 year age group (150.56%). With the exception of CT Chest and CT abdomen in the 0–1 year age group, the CTDIvol and DLP values compared favourably to international standards. Conclusion Most of the calculated DRLs are acceptable and internationally comparable. This likely indicates effective reduction techniques and protocols. Computed tomography body examination protocols for 0–1 year patients should be reviewed. Strategies should be implemented to limit higher doses in after-hours examinations.
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Affiliation(s)
- Cornelis M van der Merwe
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nasreen Mahomed
- Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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25
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Booij R, Budde RPJ, Dijkshoorn ML, van Straten M. Technological developments of X-ray computed tomography over half a century: User's influence on protocol optimization. Eur J Radiol 2020; 131:109261. [PMID: 32937253 DOI: 10.1016/j.ejrad.2020.109261] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
Since the introduction of Computed Tomography (CT), technological improvements have been impressive. At the same time, the number of adjustable acquisition and reconstruction parameters has increased substantially. Overall, these developments led to improved image quality at a reduced radiation dose. However, many parameters are interrelated and part of automated algorithms. This makes it more complicated to adjust them individually and more difficult to comprehend their influence on CT protocol adjustments. Moreover, the user's influence in adapting protocol parameters is sometimes limited by the manufacturer's policy or the user's knowledge. As a consequence, optimization can be a challenge. A literature search in Embase, Medline, Cochrane, and Web of Science was performed. The literature was reviewed with the objective to collect information regarding technological developments in CT over the past five decades and the role of the associated acquisition and reconstruction parameters in the optimization process.
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Affiliation(s)
- Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
| | - Ricardo P J Budde
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
| | - Marcel L Dijkshoorn
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
| | - Marcel van Straten
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, P.O. Box 2240, 3000 CA, The Netherlands.
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26
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Khaing M, Saw YM, Than TM, Mon AM, Cho SM, Saw TN, Kariya T, Yamamoto E, Hamajima N. Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. BMC Health Serv Res 2020; 20:742. [PMID: 32787832 PMCID: PMC7424658 DOI: 10.1186/s12913-020-05610-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.
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Affiliation(s)
- Moe Khaing
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Thet Mon Than
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Aye Myat Mon
- Medical Care Division, Department of Medical Services, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Su Myat Cho
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Thu Nandar Saw
- Department of Community and Global Health, The University of Tokyo, Tokyo, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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27
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Pasqual E, Turner MC, Gracia-Lavedan E, Casabonne D, Benavente Y, Chef IT, Maynadié M, Cocco P, Staines A, Foretova L, Nieters A, Boffetta P, Brennan P, Cardis E, de Sanjose S. Association of ionizing radiation dose from common medical diagnostic procedures and lymphoma risk in the Epilymph case-control study. PLoS One 2020; 15:e0235658. [PMID: 32649712 PMCID: PMC7351167 DOI: 10.1371/journal.pone.0235658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/21/2020] [Indexed: 11/19/2022] Open
Abstract
Medical diagnostic X-rays are an important source of ionizing radiation (IR) exposure in the general population; however, it is unclear if the resulting low patient doses increase lymphoma risk. We examined the association between lifetime medical diagnostic X-ray dose and lymphoma risk, taking into account potential confounding factors, including medical history. The international Epilymph study (conducted in the Czech-Republic, France, Germany, Ireland, Italy, and Spain) collected self-reported information on common diagnostic X-ray procedures from 2,362 lymphoma cases and 2,465 frequency-matched (age, sex, country) controls. Individual lifetime cumulative bone marrow (BM) dose was estimated using time period-based dose estimates for different procedures and body parts. The association between categories of BM dose and lymphoma risk was examined using unconditional logistic regression models adjusting for matching factors, socioeconomic variables, and the presence of underlying medical conditions (atopic, autoimmune, infectious diseases, osteoarthritis, having had a sick childhood, and family history of lymphoma) as potential confounders of the association. Cumulative BM dose was low (median 2.25 mGy) and was not positively associated with lymphoma risk. Odds ratios (ORs) were consistently less than 1.0 in all dose categories compared to the reference category (less than 1 mGy). Results were similar after adjustment for potential confounding factors, when using different exposure scenarios, and in analyses by lymphoma subtype and by type of control (hospital-, population-based). Overall no increased risk of lymphoma was observed. The reduced ORs may be related to unmeasured confounding or other sources of systematic bias.We found little evidence that chronic medical conditions confound lymphoma risk and medical radiation associations.
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Affiliation(s)
- Elisa Pasqual
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Michelle C. Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - Esther Gracia-Lavedan
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Delphine Casabonne
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
| | - Yolanda Benavente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
| | - Isabelle Thierry Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marc Maynadié
- Registre des Hémopathies Malignes de Côte d’Or INSERM U 1231, Université de Bourgogne Franche-Comté et CHU Dijon-Bourgogne, Dijon, France
| | - Pierluigi Cocco
- Department of Public Health, Clinical and Molecular Medicine, Occupational Health Section, University of Cagliari, Cagliari, Italy
| | - Anthony Staines
- School of Nursing and Human Science, Dublin City University, Glasnevin, Dublin, Ireland
| | - Lenka Foretova
- Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, Brno, Czech Republic
| | - Alexandra Nieters
- Centre of Chronic Immunodeficiency, Molecular Epidemiology, University Medical Center Freiburg, Freiburg, Germany
| | - Paolo Boffetta
- Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Paul Brennan
- IARC, International Agency for Research on Cancer, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Silvia de Sanjose
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
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Peristaltic Contrast Media Injection Improved Image Quality and Decreased Radiation and Contrast Dose When Compared With Direct Drive Injection During Liver Computed Tomography. J Comput Assist Tomogr 2020; 44:209-216. [DOI: 10.1097/rct.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Mehyar LS, Abu-Arja MH, Stanek JR, Elbeshlawi I, AbdelBaki MS. The Risk of Developing Secondary Central Nervous System Tumors After Diagnostic Irradiation From Computed Tomography in Pediatrics: A Literature Review. Pediatr Neurol 2019; 98:18-24. [PMID: 31235364 DOI: 10.1016/j.pediatrneurol.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/27/2019] [Accepted: 03/31/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Advanced diagnostic imaging has provided tremendous benefits; however, increased use of ionizing radiation modalities such as cranial computed tomography (CT) may be associated with an increased risk of developing central nervous system tumors. METHODS A literature review identified studies published for more than the last 50 years from 1968 to 2018 that explored the association between head CT scans and developing central nervous system tumors in pediatrics. We reviewed seven studies that described and analyzed the risk of brain tumors. RESULTS A positive correlation between exposure to CT scans and developing central nervous system tumors was evident in all cohorts. The strength of the association varied across the studies. Exclusion of patients with predisposing factors to central nervous system tumors was examined in four studies with a decreased risk to develop central nervous system tumors noted in three studies. Two studies reported nonsignificant reduction in the excess relative risk per milliGray of brain dose after adjusting for predisposing factors, whereas the reduction was significant in one study. The frequency of CT exposure was proportional to the risk of developing tumors in two studies although not significantly maintained in two other studies. Gender had no significant effect on the central nervous system tumor risk. The calendar year at the time of imaging showed decreasing risk in those exposed to CT in more recent years compared with prior decades. CONCLUSIONS Prospective epidemiologic studies are needed to examine the precise carcinogenic effect of exposure to ionizing radiation and help tailor further preventive measures.
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Affiliation(s)
- Lubna S Mehyar
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Ruby Memorial Hospital, Morgantown, West Virginia.
| | - Mohammad H Abu-Arja
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Stanek
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Ismail Elbeshlawi
- Pediatric Hematology/Oncology and Bone Marrow Transplantation Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Mohamed S AbdelBaki
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
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Three-dimensional analysis of sphenoid sinus uniqueness for assessing personal identification: a novel method based on 3D-3D superimposition. Int J Legal Med 2019; 133:1895-1901. [PMID: 31396701 DOI: 10.1007/s00414-019-02139-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Sphenoid sinuses are considered the most variable structures of human body: therefore, they may be used for personal identification, through the application of 3D segmentation procedures. This study aims at proposing a new protocol for personal identification based on 3D-3D superimposition of sphenoid sinuses segmented from head CT scans. Adult subjects (equally divided among males and females) who underwent two head CT scans were extracted from a hospital database. Sphenoid sinuses were segmented through ITK-SNAP software and the corresponding 3D models were automatically superimposed to obtain 40 matches (when they belonged to the same person) and 260 mismatches (when they were extracted from different individuals). The RMS (root mean square) point-to-point distance was then calculated for all the superimpositions: differences according to sex and group (matches and mismatches) were assessed through the Mann-Whitney test (p < 0.05). On average, the RMS value was almost ten times smaller in matches (0.22 ± 0.11 mm) than in mismatches (2.16 ± 0.57 mm) with a statistically significant difference according to group (p < 0.05), but not to sex (p > 0.05). The study proposed a new method for assessing personal identification from segmented 3D models of sphenoid sinuses, useful in the forensic contexts where other methods might not be implementable or successful.
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Juliusson G, Thorvaldsdottir B, Kristjansson JM, Hannesson P. Diagnostic imaging trends in the emergency department: an extensive single-center experience. Acta Radiol Open 2019; 8:2058460119860404. [PMID: 31392034 PMCID: PMC6669846 DOI: 10.1177/2058460119860404] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 12/25/2022] Open
Abstract
Background Emergency Department imaging volume has increased significantly in North America and Asia. Purpose To assess Emergency Department imaging trends in a European center. Material and Methods The institutional radiological information system was queried for all computed tomography (CT), ultrasound (US), and magnetic resonance (MR) studies performed for the Emergency Department during 2002–2017. Descriptive statistics and linear regression analyses were used to assess overall study rates and temporal trends in overall and after-hours imaging after adjusting for patient visitations. Results CT use increased significantly from 38/1000 visits to 108/1000 at the end of the observation by 5.5 new exams per 1000 visits/year (P < 0.0001). US use increased gradually at a rate of 1.2/1000 per year during 2002–2008 with an accelerated annual increase of 6.4/1000 in 2009–2011 (P < 0.0001) raising US rates from 7/1000 to 28/1000 visits per year with stable rates from 2012 onwards. After on-site MR became available in 2004, its use increased from 0.3/1000 to 7/1000 at a rate of 1.9/1000 visits per year in 2005–2009 (P < 0.0001) and remained stable from 2010. While there was a significant increase in after-hours imaging, growth remained proportional to the overall trend in the use of CT, MR, and night-time CT with the exception of a slight decrease in after-hour US in favor of standard working hours (P < 0.0001). Conclusion All modalities increased significantly in volume adjusted usage. US and MR rates have been stable since 2012 and 2010, respectively, after periods of increase while CT use continues to increase. Demand for after-hours imaging was mostly proportional to the overall trend.
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Affiliation(s)
- Gunnar Juliusson
- Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Petur Hannesson
- Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland
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Correspondence: Submillisievert CT angiography for carotid arteries using wide array CT scanner and latest iterative reconstruction algorithm in comparison with previous generations technologies: Feasibility and diagnostic accuracy. J Cardiovasc Comput Tomogr 2019; 13:299-300. [PMID: 30962032 DOI: 10.1016/j.jcct.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 12/22/2022]
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Extent of tube-current reduction using sinogram affirmed iterative reconstruction in pediatric computed tomography: phantom study. Pediatr Radiol 2019; 49:51-56. [PMID: 30259068 DOI: 10.1007/s00247-018-4260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/12/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Iterative image reconstruction techniques can produce diagnostic-quality computed tomography (CT) images with lower radiation dose. OBJECTIVE To quantify the reduction in x-ray tube-current setting and optimize pediatric CT scans using different strengths of an iterative reconstruction technique. MATERIALS AND METHODS The head, chest and abdomen regions of an anthropomorphic phantom representing a 5-year-old patient were scanned using standard CT protocols. Images were reconstructed using filtered back projection and different strengths of a sinogram affirmed iterative reconstruction technique. Repeated measurements of contrast-to-noise ratios in the lungs, bone and soft-tissue regions of the phantom were carried out. Maximum increase in contrast-to-noise ratio with iterative reconstruction strength was identified and a tube-current reduction factor was calculated. Head scans were repeated with reduced tube current and compared to filtered back projection images. RESULTS Iterative reconstruction strength of 3 for head and chest images and 4 for abdomen images were optimum, resulting in contrast-to-noise ratio increase of about 50%. A tube-current reduction factor of 1.2 for head images was calculated. Images of the head acquired using reduced tube-current showed similar contrast-to-noise ratio as images form filtered back projection with full tube current. CONCLUSION Optimum strength of iterative reconstruction technique has been identified for head, chest and abdomen images. Reductions in tube current of 20%, resulting in similar radiation dose reduction, have been established.
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Bosch de Basea M, Moriña D, Figuerola J, Barber I, Muchart J, Lee C, Cardis E. Subtle excess in lifetime cancer risk related to CT scanning in Spanish young people. ENVIRONMENT INTERNATIONAL 2018; 120:1-10. [PMID: 30053755 DOI: 10.1016/j.envint.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND CT scan is a life-saving medical diagnostic tool, entailing higher levels of ionising radiation exposure than conventional radiography, which may result in an increase in cancer risk, particularly in children. Information about the use and potential health effects of CT scan imaging among young people in Spain is scarce. OBJECTIVE This paper aims to estimate the number of radiation-related cancer cases which can be expected due to the use of CT scanning in Spanish children and young adults in a single year (2013). METHODS The 2013 distribution of number and types of CT scans performed in young people was obtained for Catalonia and extrapolated to the whole Spain. Organ doses were estimated based on the technical characteristics of 17,406 CT examinations extracted from radiology records. Age and sex-specific data on cancer incidence and life tables were obtained for the Spanish population. Age and sex-specific risk models developed by the Committee on Health Risks of Exposure to Low Levels of Ionizing Radiations (BEIR VII) and Berrington de Gonzalez were used, together, with the dose estimates to derive the lifetime attributable risks of cancer in Spain due to one year of CT scanning and project the number of future cancer cases to be expected. RESULTS In 2013, 105,802 CT scans were estimated to have been performed in people younger than age 21. It was estimated that a total of 168.6 cancer cases (95% CrI: 30.1-421.1) will arise over life due to the ionising radiation exposure received during these CTs. Lifetime attributable risks per 100,000 exposed patients were highest for breast and lung cancer. The largest proportion of CTs was to the head and neck and hence the highest numbers of projected cancer cases were of thyroid and oral cavity/pharynx. CONCLUSIONS Despite the undeniable medical effectiveness of CT scans, this risk assessment suggests a small excess in cancer cases which underlines the need for justification and optimisation in paediatric scanning. Given the intrinsic uncertainties of these risk projection exercises, care should be taken when interpreting the predicted risks.
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Affiliation(s)
- Magda Bosch de Basea
- Institut de Salut Global (ISGlobal), Centre de Recerca en Epidemiologia Ambiental, Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - David Moriña
- Unit of Infections and Cancer (UNIC-I & I), Catalan Institute of Oncology (ICO)-IDIBELL, Av Gran Via, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Figuerola
- Institut de Salut Global (ISGlobal), Centre de Recerca en Epidemiologia Ambiental, Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ignasi Barber
- Radiology department, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Jordi Muchart
- Radiology department, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD, United States
| | - Elisabeth Cardis
- Institut de Salut Global (ISGlobal), Centre de Recerca en Epidemiologia Ambiental, Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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The Current State of CT Dose Management Across Radiology: Well Intentioned but Not Universally Well Executed. AJR Am J Roentgenol 2018; 211:405-408. [DOI: 10.2214/ajr.17.19266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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An innovative 3D-3D superimposition for assessing anatomical uniqueness of frontal sinuses through segmentation on CT scans. Int J Legal Med 2018; 133:1159-1165. [PMID: 30039273 DOI: 10.1007/s00414-018-1895-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
Anatomical uniqueness plays a significant role in the personal identification process of unknown deceased. Frontal sinuses have been widely used in the past decades for this purpose, mostly using 2D X-ray techniques. However, the modern 3D CT-based segmentation methods may help in developing novel and more reliable methods of identification. This study aims at assessing the anatomical uniqueness of frontal sinuses through the 3D model registration. Thirty subjects who underwent two maxillofacial CT scans (interval: 1 month to 5 years) were selected from a hospital database. Frontal sinuses were automatically segmented through ITK-SNAP open source software and the 3D models belonging to the same patient were automatically superimposed according to the least point-to-point difference between the two surfaces. Two hundred patients were randomly selected from the same database and undergo the same procedure to perform 200 superimpositions of frontal sinuses belonging to different individuals, equally divided between males and females (mismatches). Statistically significant differences of average root mean square (RMS) point-to-point distance between the group of matches and mismatches, as well as possible differences according to sex, were assessed through Mann-Whitney U test (p < 0.05). In the group of matches, RMS ranged between 0.07 and 0.96 mm (mean RMS 0.35 ± 0.23 mm), while in the group of mismatches, it ranged between 0.96 and 10.29 mm (mean RMS 2.59 ± 1.79 mm), with a statistically significant difference (p < 0.0001). Neither the matches nor the mismatches group showed statistically significant differences according to sex. This study proposes a novel 3D approach for the assessment of anatomical uniqueness of frontal sinuses, providing both morphological and quantitative analysis, and a new method of identification based on 3D assessment of frontal sinuses, applicable when ante-mortem CT scans are available.
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Abstract
BACKGROUND Radiation exposure is a well-known risk factor for thyroid cancer. However, the specific effects of diagnostic radiation exposure on thyroid cancer risk are controversial. The purpose of this study was to perform a systematic review and meta-analysis to assess the effects of diagnostic radiation exposure on thyroid cancer risk. METHODS The PubMed and EMBASE databases were searched to identify eligible studies. Summary odds ratio (OR) estimates and confidence intervals (CIs) were used to compute the risk of thyroid cancer using fixed- and random-effects models. Subgroup and sensitivity analyses were performed to evaluate the potential heterogeneity. RESULTS Nine studies from 12 publications were included in the meta-analysis. Overall exposure to diagnostic radiation exposure was associated with a significantly increased thyroid cancer risk (OR = 1.52 [CI 1.13-2.04]). The subgroup and sensitivity analyses revealed similar results. By type of exposure, exposure to computed tomography scans (OR = 1.46 [CI 1.27-1.68]) or dental x-rays (OR = 1.69 [CI 1.17-2.44]) were associated with an increased thyroid cancer risk. Head and neck (OR = 1.31 [CI 1.02-1.69]) and chest (OR = 1.71 [CI 1.09-2.69]) exposure to diagnostic radiation was associated with an increased thyroid cancer risk. CONCLUSIONS The results of this meta-analysis indicate that diagnostic radiation exposure is associated with an increased thyroid cancer risk. Therefore, to the extent that it will not compromise the information being sought, radiation exposure to the thyroid should be minimized during diagnostic examinations.
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Affiliation(s)
- Mi Ah Han
- 1 Department of Preventive Medicine, College of Medicine, Chosun University , Korea
| | - Jin Hwa Kim
- 2 Department of Internal Medicine, College of Medicine, Chosun University , Korea
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Meulepas JM, Smets AMJB, Nievelstein RAJ, Gradowska P, Verbeke J, Holscher HC, Rutten MJCM, Kieft M, Ronckers CM, Hauptmann M. Trends and patterns of computed tomography scan use among children in The Netherlands: 1990-2012. Eur Radiol 2016; 27:2426-2433. [PMID: 27709278 DOI: 10.1007/s00330-016-4566-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 08/07/2016] [Accepted: 08/18/2016] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate trends and patterns in CT usage among children (aged 0-17 years) in The Netherlands during the period 1990-2012. METHODS Lists of electronically archived paediatric CT scans were requested from the Radiology Information Systems (RIS) of Dutch hospitals which reported >10 paediatric CT scans annually in a survey conducted in 2010. Data included patient identification, birth date, gender, scan date and body part scanned. For non-participating hospitals and for years prior to electronic archiving in some participating hospitals, data were imputed by calendar year and hospital type (academic, general with <500 beds, general with ≥ 500 beds). RESULTS Based on 236,066 CT scans among 146,368 patients performed between 1990 and 2012, estimated annual numbers of paediatric CT scans in The Netherlands increased from 7,731 in 1990 to 26,023 in 2012. More than 70 % of all scans were of the head and neck. During the last decade, substantial increases of more than 5 % per year were observed in general hospitals with fewer than 500 beds and among children aged 10 years or older. CONCLUSION The estimated number of paediatric CT scans has more than tripled in The Netherlands during the last two decades. KEY POINTS • Paediatric CT in The Netherlands has tripled during the last two decades. • The number of paediatric CTs increased through 2012 in general hospitals. • Paediatric CTs continued to increase among children aged 10 years or older.
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Affiliation(s)
- Johanna M Meulepas
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Anne M J B Smets
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | | | - Patrycja Gradowska
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jonathan Verbeke
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Herma C Holscher
- Department of Radiology, HAGA Hospital/Juliana Children's Hospital, The Hague, The Netherlands
| | | | - Mariëtte Kieft
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Department of Paediatric Oncology Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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The changing use of pediatric CT in Australia. Pediatr Radiol 2016; 46:1199-208. [PMID: 26952101 DOI: 10.1007/s00247-016-3563-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/16/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the medical benefits of CT, there are concerns about increased cancer risks following CT scans in childhood. OBJECTIVE To assess Australian temporal trends in pediatric CT scans funded through Medicare over the period 1985 to 2005, as well as changes in the types of CT scanners used. MATERIALS AND METHODS We studied de-identified electronic records of Medicare-funded services, including CT scans, that were available for children and adults younger than 20 years between 1985 and 2005. We assessed temporal trends using CT imaging rates by age, gender and anatomical region. Regulators provided CT scanner registration lists to identify new models installed in Australia and to date the introduction of new technologies. RESULTS Between 1985 and 2005, 896,306 Medicare-funded CT services were performed on 688,260 individuals younger than 20 years. The imaging rate more than doubled during that time period. There were more than 1,000 CT scanners on registration lists during the study period. There were both a sharp increase in the availability of helical scanning capabilities from 1994 and significant growth in multi-detector CT scanners from 2000. CONCLUSION Significant increases in the rate of pediatric CT scanning have occurred in Australia. This rate has stabilized since 2000, possibly a result of better understanding of cancer risks.
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